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January is the month for resolutions, and getting fit is often at the top of the list.  Maybe this is the year it will happen for you!  As a former couch potato who never exercised before the age of 42, my message to women of all ages is this, “It’s NEVER too late to get in shape!”  When I made the decision to take control of my health, it became one of the most important decisions of my life.  Fitness helped me to lose 65 pounds, lower my blood pressure and acquire an amazing new sense of wellness, strength and energy to finally enjoy life to its fullest.  It was truly empowering to spend my 50th birthday hiking and rock climbing in Tahoe… something I could not have done at 20, 30 or 40!

More importantly, regular exercise increases bone density and significantly decreases the risk of life-threatening or debilitating diseases.  Even if these illnesses take an unwelcome place in our lives, we can improve or reverse them with a consistent fitness routine.  These conditions include:

·          Heart Attack & Stroke

·          Diabetes

·          High Cholesterol

·          High Blood Pressure

·          Osteoporosis

·          Insomnia

·          Depression 

Cardiovascular Exercise

  Cardiovascular exercise such as walking, running, swimming, bicycling, aerobic classes, etc. are paramount to any exercise program.  These activities increase heart rate to burn calories and strengthen the heart and lungs.  No one will argue that cardiovascular exercise should be part of almost everyone’s lifestyle.  Beginners can start gradually; even a few minutes a day of walking is a place to start.  Adding minutes, speed and/or intensity as the body adapts to exercising will bring you to your peak fitness level, little by little.  Always start your cardiovascular session with a five-minute warm up and end it with a five-minute cool down period.  Example:  start walking at a slow pace and gradually increase your speed after five minutes.  Your heart rate will increase slowly and safely.  As you pick up the pace and start working your heart and lungs, you can check your workout intensity by doing the simple “Talk Test”.  You should be able to speak a complete sentence before gasping for air.  If not, slow down your pace a bit.  On the other hand, if you are able to speak more than a sentence before gasping for air, you should probably speed up a little.  Then, always remember to slow down again for the last five minutes to bring the heart rate down slowly.  This will prevent light-headedness or nausea from occurring after the workout.  You can use the talk test for any type of cardiovascular exercise.

Strength Training

  What about strength training for women?  Why are so many of us joining the gym and pumping iron alongside the men?  There are many good reasons.  Challenging weight-bearing exercise increases bone density far better than a cardiovascular program alone.  Additionally, more lean mass (muscle) increases metabolism so we can eat more without gaining, and reduce body fat more effectively.  The fear many women have when it comes to lifting weights is that they will “bulk up”.  Fortunately, this is not a realistic fear.  The female body builders you have seen on television are lifting seven days a week for several hours a day, and the massive muscles you have seen on some of these women are due to the use of steroidal drugs.  Women engaging in a two or three hours per week strength training program, for example, will not “bulk up”.  Women should also be happy to hear that for every pound of muscle they build, the body burns an extra 35 to 60 calories per day.  Furthermore, women who engage in resistance training maintain an elevated metabolism for up to two hours after the workout, burning approximately 100 additional calories post-workout.


  Here is an example of how muscle works to increase metabolism:  Barbara and Betty are fictional identical twins.  They are each 5’3” and both weight 130 pounds.  Both eat healthfully and participate in regular cardiovascular activities.  When Barbara began a comprehensive strength training program three times per week, her weight did not change, but her measurements began to drop.  When purchasing identical dresses for their high school reunion, Barbara fit into a size 6 and Betty fit in a size 8 even though they were both still weighing in at 130 pounds.  Muscle is more compact than fat.  Additionally, the body requires more calories to maintain lean mass than fat; therefore, the twin who lifts weights will be able consume more calories than her sister without gaining body fat.


  Women and men who are beginning a strength training program should be very aware of the importance of proper form and program design to avoid creating muscle imbalances and joint or muscle injury.  Improper programming and load preparation can result in a variety of serious injuries.  Often it is repetitive and incorrect form that eventually leads to inflammation and injury of a muscle or joint.  The most common injury seen in exercisers with improper program design is the famous “torn rotator cuff”.  The rotator cuff is a thin membrane surrounding the shoulder joint.  It lies under the shoulder muscles called the deltoids.  When an individual performs chest-strengthening exercises such as a “chest press machine”, the chest and front deltoid muscles become stronger and tighter.  If the horizontal upper back and rear deltoid muscles are not equally challenged with a proper “row” exercise, a muscle imbalance will gradually occur on the shoulder joint.  As the chest becomes tighter, it will pull the shoulders forward toward the stronger muscle and eventually one day, when you least expect it, the rotator cuff will tear.  Even if the row exercise is included, many people do it incorrectly and the back muscles do not end up strengthening adequately.  When folks join a gym, they will often do the machines they like and omit the less-enjoyable ones.  It is important to realize that there is risk in doing so.


Getting Started

  It is not advisable to begin strength training without professional instruction and a clear plan for meeting your fitness goals.     Hiring a nationally certified and/or degreed personal trainer is a good idea for beginners before attempting a solo workout in the gym.  Choosing a trainer can be as important as the workout itself.  Many gyms employ uncertified trainers at a low wage and, since the gym will offer a short course to their employees and create a “certification” of their own, it is prudent to ask questions to ascertain the trainer’s   qualifications and experience.  A few of the most highly respected certification programs in the country are:

·          The National Academy of Sports Medicine

·          The American Council on Exercise

·          The National Strength and Conditioning Association

·          Aerobics and Fitness Association of America

With college degrees, look for a major in kinesiology or exercise science.  Degreed and nationally certified trainers have had to pass lengthy, rigid testing on biomechanics of the human body, the kinetic chain, program design, and injury prevention.  To maintain certification, 16-20 hours of continuing education credits must be obtained every two years as well.


  For those with time and budget constraints that prevent the possibility of working with a trainer, look for a well-written and illustrated book that can help you learn to design your own program and teach you proper form to avoid injury.  There are also on-line programs available now to help those who want to learn and progress on their own.  Pages can be printed from the internet and carried with you to the gym to follow as you work through the exercises.


  Yes, 2006 is another new year. Whether you are 18 or 88, why not let this be the year you decide to make exercise a part of your lifestyle. There are so many good reasons to do so, and so many bad reasons not to. Remember – it truly is NEVER too late to get in shape!


By:   Brenda Dahm Kashuba, CPT, LWMC,    Owner, 4EverFit Personal Training Studio

Brenda opened 4EverFit in 2001 to provide an environment for those preferring more privacy than that available in membership-based gyms and where clients could be sure of receiving only experienced,  professional, nationally certified trainers.          

Visit her website at  http://www.4everfit.org



What You Should Know About Coffee/Caffeine

Coffee is currently among the most widely consumed beverages around the world.  In America, 52% of adults drink coffee every day, with another 28% drinking it occasionally.  Is this a healthy habit, or one that is detrimental to the health?  It turns out that coffee/caffeine has both risks and benefits depending on how it is prepared and the health issue being examined. 

Cardiovascular Disease

  There are 2 components of coffee (cafestol and kahweol) that

Caffeine Content of Common Drinks


Caffeine Content

Coffee, brewed from grounds, (8 fl oz)

95 mg

Espresso  (1 fl oz)

64 mg

Decaffeinated coffee,

(8 fl oz.)

2 mg

Tea (8 fl oz)

47 mg

Cola beverage (12 fl oz)

37 mg

Milk Chocolate (1.55 oz)



can raise serum cholesterol including the harmful LDL

(low-density lipoprotein) cholesterol.  However, when a paper

filter is used for brewing coffee, these substances remain in the

filter.  Instant coffee also contains very little of these substances. 

In contrast, coffee that is not filtered (i.e., French press, cafetiere,

boiled, Turkish/Greek) can raise cholesterol and thus raise the

risk of cardiovascular disease such as heart attacks and strokes. 


  Caffeine intake increases blood pressure though this effect

decreases with chronic consumption.  One study of  long-term

users showed that systolic BP increased by 2.4 mm and diastolic

BP by 1.2 mm, a modest effect.  This does not occur with

decaffeinated coffee and thus is a direct effect of the caffeine. 


  Caffeine may also increase homocysteine levels which are

generally associated with increased risks of heart disease.  It does

not appear to increase the risk of serious cardiac arrhythmias.  It

may have some beneficial effects by increasing antioxidants.

  Studies looking at the effect of coffee/caffeine on heart attacks and strokes as an endpoint instead of risk factors that are associated with heart disease have had mixed results.  The Nurses’ Health Study, a large cohort study of US women revealed that drinking 6 or more cups of coffee a day was not associated with a higher risk of heart disease during 10 years of follow-up.  This suggests there may be little overall effect of filtered coffee on risk of heart disease.    


  Recent studies have reported that higher coffee consumption is associated with a substantially lower risk of type 2 diabetes.  This was shown in US women who drank 4 or more cups of coffee per day, and for both   regular and decaffeinated coffee.  Coffee may lower insulin sensitivity by increasing epinephrine, but there may be effects on other aspects of glucose metabolism as well. 


  Early studies suggested an increase in pancreatic and bladder    cancer and a decrease in colon cancer with caffeine consumption.    These    studies have not been convincingly reproduced.  Likewise, studies on breast cancer have shown both detrimental and beneficial effects.  Overall, the  association between coffee consumption and several types of cancer has been studied extensively and is largely reassuring. 

Pregnancy/Birth Outcomes

  A recent study reported a higher risk of stillbirths for women consuming 8 or more cups of coffee per day.  This was not true for women consuming less than 4.  The increased association with stillbirths could be related to other lifestyle factors in that group of women so a definite causal relationship between coffee/caffeine and birth outcomes is inconclusive.  However, caffeine does cross the placenta and does reach the fetus.  Therefore it seems prudent to avoid high caffeine intake during pregnancy.  We would recommend no more than 200 mg/day or less (i.e., two cups of regular coffee per day).

Bone Health

  Caffeine reduces intestinal absorption of calcium, but this effect is very small.  It can be offset by 1 to 2 tablespoons of milk per day.  Caffeine should not be a problem for bone health as long as women have adequate calcium intake.

Other Potential Health Effects

  Regular coffee consumption has been associated with a lower risk of symptomatic gallstone disease in women.  It also appears to have a beneficial effect on the risk of Parkinson’s disease.  However, it is premature to advise higher coffee consumption as a means of lowering the risk of these condition.  More studies on these and other health conditions are needed. 



El Camino Women's Medical Group provides comprehensive Obstetric & Gynecologic care for patients throughout the Bay Area. Minimally invasive surgery, infertility, women's mental health, and the MonaLisa Touch are just a few of the specialized services we offer.
The MonaLisa Touch treatment is available at El Camino Women's Medical Group. Call the office (650-396-8110) or email Shar (Shar@ElCaminoWomen.com) for more information.
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